AB1399 INVESTIGATING THE USE OF VERTEBRAL HEIGHT MORPHOMETRY DATA AS A PREDICTOR OF FRACTURE: AN OBSERVATIONAL COHORT STUDY
Authors: H. Amin, M. Bukhari, A. Khan
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Dual energy x-ray absorptiometry (DEXA) has an established place in the diagnosis of osteoporosis and fracture risk estimation using the FRAX® tool. DEXA is also useful in producing morphometry data on bones including the vertebrae at low radiation doses during appointments. Currently there exists limited clinical use for vertebral height measurement, with no data published on the use of vertebral height as a useful clinical measurement. FRAX currently uses bone mineral density from the hip to calculate the risk of either hip fracture or major osteoporotic fracture, however, previous literature has identified that BMD as a predictor of fracture is specific but not sensitive [1]. Moreover, it may not be possible to get such value in certain patient demographics such as patients with hip replacements. Therefore, further data and predictors of fractures are needed to better allow fracture risk estimation. <h3>Objectives</h3> The aims of this study is to assess the use of vertebral height data measured during routine DEXA appointments as a predictor of fracture in an observational cohort. <h3>Methods</h3> We analysed data on 31546 patients referred to a district BMD scanner in the northwest of England between 2004-2019. Data collected at attendance include site of fragility fracture and the vertebral height at lumbar vertebrae L1-L4. Logistic models reporting odds ratio were used to examine the predictive value of vertebral height at L1-L4 in different types of fragility fracture. <h3>Results</h3> The mean age at the time of the first scan was 65 +/- 12.9 (SD). Our dataset comprised 26,156 (82.9%) female and 5390 (17.1%) male patients. A total of 11875 fractures occurred in our population. The mean height at L1 was 3.117 (95% CI 3.117-3.12), L2: 3.239 (95% CI 3.236-3.242), L3:3.78 (95% CI:3.75-3.381) and L4: 3.424 (95% CI: 3.420-3.428). Patients with average vertebral height at these spinal levels were less likely to experience any type of fracture. Interestingly when running the analysis individually at each fracture site, different spinal levels were associated with fractures at different sites. L1 had the highest predictive value while L2 had the least. <h3>Conclusion</h3> This study is the first to analyse the use of vertebral height data. We found that average vertebral height at spinal level L1-L4 is protective for fragility fractures however specific spinal levels were protective for certain types of fracture. While the link between BMD and fracture has been known for some time and consequently has been integrated into risk estimation tool such as FRAX®, the use of morphometry data to predict fracture is novel. Further research is needed to compare the predictive power of BMD to morphometry data as predictors of fracture, as well as understanding the role of morphometry data in future iterations of fracture risk estimation tools. <h3>Reference</h3> [1]El Miedany Y. FRAX: re-adjust or re-think. Arch Osteoporos. 2020 Sep 28;15(1):150. doi: 10.1007/s11657-020-00827-z. PMID: 32989561; PMCID: PMC7522068. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Hamzah amin: None declared, Marwan Bukhari Speakers bureau: Marwan Bukhari has been sponsored to attend regional, national and international meetings by UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Janssen, Bristol-Myers Squib, Novartis and Eli-lilly He has received honoraria for speaking and attended advisory boards with Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen, Novartis and Gilead. He has received honoraria from educational groups revalidaid and TREG consultants., Aqib Khan: None declared.